When LDL Cholesterol Is Not LDL Cholesterol: LpX, A Clinical Lesson

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Differential Effects of Lipid-lowering Drugs in Modulating Morphology of Cholesterol Particles
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Published on: November 10, 2017

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Lisa P M Huygen1, Jan Westerink2, Gerben C Mol3

  • 1Department of Internal Medicine, Gelderse Vallei Hospital, Ede, the Netherlands.

JACC. Case Reports
|June 9, 2022
PubMed

Insights

Lipoprotein X (LpX) is a lipid particle found in cholestasis, distinct from LDL-C. Diagnosing LpX involves checking ApoB levels, and treatment targets cholestasis, not just lipids.

Area of Science:

  • Biochemistry
  • Clinical Lipidology
  • Hepatology

Background:

  • Cholestatic liver conditions lead to the formation of abnormal lipoproteins.
  • Lipoprotein X (LpX) is a specific marker associated with cholestasis.
  • LpX is frequently misidentified as Low-Density Lipoprotein Cholesterol (LDL-C).

Observation:

  • LpX possesses unique biochemical properties differentiating it from LDL.
  • Apolipoprotein B (ApoB) levels are inversely correlated with LpX presence.
  • Standard lipid panels may inaccurately quantify LpX as LDL-C.

Findings:

  • Low Apolipoprotein B (ApoB) levels can serve as a diagnostic indicator for LpX.
  • Distinguishing LpX from LDL-C is crucial for appropriate patient management.
  • Therapeutic strategies should prioritize addressing the underlying cholestatic process.

Implications:

  • Accurate identification of LpX can prevent inappropriate lipid-lowering therapies.
  • Understanding LpX aids in the etiological diagnosis of liver disease.
  • Management guidelines may need refinement to incorporate LpX diagnostics and targeted cholestasis treatment.

Keywords:
ApoB, apolipoprotein BHDL, high-density lipoproteinHDL-C, high-density lipoprotein cholesterolLDL, low-density lipoproteinLDL-C, low-density lipoprotein cholesterolLpX, lipoprotein XTC, total cholesterolVLDL, very-low-density lipoproteinapolipoprotein Bcholestasishypercholesterolemialipoprotein X

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